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72 Cards in this Set
- Front
- Back
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goals of early SCI management
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- minimise secondary SC damage
- prevent complications from altered physiology |
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why may associated injuries be masked
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loss of pain sensation below injury
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define spinal level of injury
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lowermost neurologically intact segment
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define complete lesion
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no voluntary motor or sensory function preserved more than 3 segs below injury
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define spinal shock
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diminished excitability of isolated SC
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what level spinal injury will result in loss sympathetic vascular tone
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above T6
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why are low cervical/high thoracic assoc with resp insufficiency
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paralysis intercostals, abdomonial mm. cough impaired
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prophylaxis for SCI
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- PPI: stress ulceration
- anticoag: DVT - catherisation: bladder distension - prevention mm. contracture |
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location somatic motor neuron?
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lamina IX
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LMN signs
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- paralysis
- wasting - flaccidity - areflexia |
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UMN features
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- paresis
- spasticity - hyper-reflexia |
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what allows integration across spinal segments?
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intersegmental axons (propriospinal fibres)
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where does dorsal SCT recieve proprioceptive input from?
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- deep tissue
- mm. tendons - joints |
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what structure determines conciousness of movement?
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thalamic relay
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which laminae do STT fibres synapse?
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I, V
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filum terminale is a free structure
T/F |
F - anchors to sacrum, coccyx below
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how many segments does the SC have and where does it extend to?
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31 segments.
to L1/L2 |
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what level is a LP done
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L4/L5
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where are autonomic preganglionic neurons found
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- intermediolateral
- intermediolmedial |
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what laminae are in DH/VH/intermediate grey
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DH - I-V
VH - VIII, IX intermediate grey - VI, VII, X |
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when can spinal shock happen
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- trauma
- inflammation - ischaemia note: more common in abrupt than chronic pathology |
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theories of spinal shock
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- disruption descending excitation
- increase in local inhibition - change in receptor function |
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why can bradycardia be present in spinal shock?
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- impaired sym innervation
- preserved parasym function |
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fluid therapy is recommended for spinal shock
T/F |
F - recommended for hypovolaemic shock. leads to fluid overload in spinal shock. ionotropic treatment is recommended.
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following spinal shock reflexes below injury become hyperreflexive
T/F |
T
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contraction of detrusor maintains continence
T/F |
F - contraction trigone, internal and external sphincters maintain contraction.
detrusor contracts during micturition |
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what happens on increase in visceral afferents from detrusor?
(continence) |
- inhibition of PNS innervation
- excitation of external sphincter by somatic pudendal |
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what positive feedbacks to pontine micturition centre?
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- bladder afferents (excited by bladder contraction)
- urethral afferents |
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what does the pudendal n. supply?
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- pelvic floor mm.
- external urethral spinchter - external anal spinchter |
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sympathetic n. play little role in defaecation reflex
T/F |
T
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what mm. assist in defecation reflex?
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- abd wall mm.
- thoracic mm. - diaphragm |
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what is the aim of rehabilitation in SCI pt.?
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- maximise independance
- assist psych adjustment - reintegrate into community, workplace |
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what factors are associated with a good outcome after injury?
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- young age
- female - higher educational elvel - ability to relate well - confidence |
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definition of chronic pain?
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longer than 3 months
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what factors need to be taken into account for pain assessment?
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- what structures involved
- what pathology producing pain - psychosocial factprs |
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in chronic pain psychosocial factors are likely to play a bigger role
T/F |
T
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what inducts the neural plate and when?
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mesoderm, 18d
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when do various aspects of the neural tube close?
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midline - 22d
crandial - 24d (-26) caudal - 26d (-28) |
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what is secondary neurulation?
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fusion fo the caudal neuropore with solid neural cord and extension of neural cavity into solid cord
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what is the sulcus limitans?
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separates alar (dorsal) and basal (ventral) columns
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what are the five vesicles?
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- telencephalon
- diencephalon - mesencephalon - metencephalon - mylencephalon |
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which part of the CNS does not complete mitosis by 16 weeks?
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cerebellum
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what is the difference between spina bifida and spina bifida cystica?
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cystica defect of underlying SC, nerve roots and coverings not just bony defect
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meningocele is more common than myelomeningocele
T/F |
F - though less serious, it is rarer and embryologically occurs later than the myelomeningocele
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what may overly spina bifida occulta?
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- naevus
- hair tuft - lipoma - dimple |
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what are features of a particularly caudal myelomeningocele?
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lower limb function maybe spared, but bowel/bladder still affected
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what BS dysfunction can be seen with chiari II malformation?
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- bulbar paresis
- vocal cord paralysis |
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hydrocephalus in association with chiari II malformation occurs because of what obstruction?
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4th ventricle obstruction
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what is CSF low in compared to plasma?
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K, Mg, Ca, glucose, protein, WBC
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where are the various ventricles derived from?
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lateral - telencephalon
third - diencephalon fourth - rhombencephalon |
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what two features limit access across BBB?
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- molecule size
- lipid solubility |
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whats the difference between normal ependyma and choroid plexus?
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tight junction
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what drug is used to target carbonic anhydrase associated CSF production?
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acetazolamide
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what drives CSF from arachnoid villi into venous sinus
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hydrostatic gradient
(absorption is pressure dependant) |
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most critical assessment in epilepsy diagnosis/management?
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clinical interviews
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in what percentage of people is aeitiology of epilepsy unsure?
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60%
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after a single seizure, which Ix is more important EEG or MRI
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MRI
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what definitively defines epilepsy
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recording of a seizure with EEG
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EEGs have a role in determining response to AED
T/F |
F
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three general goals of AED?
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- limit firing frequency of neurones
- decrease neuronal excitation - increase neuronal inhibition |
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what is MOA of phenytoin
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limit firing frequency
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what is MOA phenobarbitone
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reduce neural release glutamate
enhance activation of GABA-a activate GABA-R |
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what is MOA carbemazepine
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limit firing frequency
reduce neural release glutamate |
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which drugs inhibit metabolism of GABA
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sodium valproate
vigabatrin |
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what are some issues with AED?
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- compliance
- individualisation of dose - monitoring - monotherapy |
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what is the significance of a narrow therapeutic index?
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narrow range between minimum effective plasma concentration and drug concentration above which SE/toxicity occurs
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for which AED is TDM particularly useful?
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- phenytoin
- carbamazepine - sodium valproate |
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what percentage of poor epilepsy control is due to non-compliance?
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50%
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when is TDM not used?
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- clinical endpoint can be measured e.g. BP
- no correlation between plasma conc. and effect e.g. effect present without detectable plasma conc. - parent drug has active metabolites which produce effect |
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what factors influence TDM?
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- when sample collected in relation to dosing
- recent dose adjustment, stead state - correct dosing hx |
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dose requirements of AED increase in pregnancy
T/F? |
T
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what are three subsets of discrimination?
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- legal discrimination
- enacted stigma - perceived or felt stigma (non-disclosure) |
